Inside Health

WELL; Personal Health: Communities Learn the Good Life Can Be a Killer

By JANE E. BRODY

Published: January 31, 2012

Developers in the last half-century called it progress when they built homes and shopping malls far from city centers throughout the country, sounding the death knell for many downtowns. But now an alarmed cadre of public health experts say these expanded metropolitan areas have had a far more serious impact on the people who live there by creating vehicle-dependent environments that foster obesity, poor health, social isolation, excessive stress and depression.

As a result, these experts say, our ''built environment'' - where we live, work, play and shop - has become a leading cause of disability and death in the 21st century. Physical activity has been disappearing from the lives of young and old, and many communities are virtual ''food deserts,'' serviced only by convenience stores that stock nutrient-poor prepared foods and drinks.

According to Dr. Richard J. Jackson, professor and chairman of environmental health sciences at the University of California, Los Angeles, unless changes are made soon in the way many of our neighborhoods are constructed, people in the current generation (born since 1980) will be the first in America to live shorter lives than their parents do.

Although a decade ago urban planning was all but missing from public health concerns, a sea change has occurred. At a meeting of the American Public Health Association in October, Dr. Jackson said, there were about 300 presentations on how the built environment inhibits or fosters the ability to be physically active and get healthy food.

In a healthy environment, he said, ''people who are young, elderly, sick or poor can meet their life needs without getting in a car,'' which means creating places where it is safe and enjoyable to walk, bike, take in nature and socialize.

''People who walk more weigh less and live longer,'' Dr. Jackson said. ''People who are fit live longer. People who have friends and remain socially active live longer. We don't need to prove all of this,'' despite the plethora of research reports demonstrating the ill effects of current community structures.

The Price of Progress

''We've become the victims of our own success,'' Dr. Jackson said of the public health mission that cleared cities of congested slums. ''By living far from where we work, we reduced crowding and improved the quality of our air and water, which drove down rates of infectious disease.'' But as people have moved farther and farther from where they work, shop and socialize, the rates of chronic diseases have soared.

Public transportation has not kept pace with the expansion of suburbs and exurbs. Nor are there enough sidewalks, nearby parks and safe places to walk, cycle or play outdoors in many, if not most, towns. Parents spend hours in cars getting to and from work; children are bused or driven to and from school; and those who can't drive must depend on others to take them everywhere or risk becoming socially isolated.

In 1974, 66 percent of all children walked or biked to school By 2000, that number had dropped to 13 percent.

''Children who grow up in suburbia can't meet their life needs without getting a ride somewhere,'' Dr. Jackson said. ''The average teen in suburbia says it's boring.''

His new book, ''Designing Healthy Communities,'' a companion piece to a coming public television series, says: ''When there is nearly nothing within walking distance to interest a young person and it is near-lethal to bicycle, he or she must relinquish autonomy - a capacity every creature must develop just as much as strength and endurance.'' The book was written with Stacy Sinclair, director of education at the Media Policy Center in Santa Monica, Calif.

''We've engineered physical activity out of children's lives,'' Dr. Jackson said in an interview. ''Only a quarter of the children in California can pass a basic fitness test, and two in seven volunteers for the military can't get in because they're not in good enough physical condition.''

The health consequences, he said, are terrifying. Not only are Americans of all ages fatter than ever, but also growing numbers of children are developing diseases once seen only in adults: Type 2 diabetes, heart disease and fatty livers.

Can Our Suburbs Be Saved?

The four-part series that Dr. Jackson developed with the documentary producers Dale Bell and Harry Wiland, to be broadcast in the spring, highlights changes being made in forward-thinking communities - changes that foster better physical and mental health by redesigning the built environment.

''Health happens in neighborhoods, not doctors' offices,'' Dr. Jackson states in one of the programs.

Metropolitan Atlanta, which is 8,000 square miles and growing and where workers drive an average of 66 miles a day, has suffered the ill effects of high ozone levels, few sidewalks and bike lanes, and crosswalks as much as a mile apart. In what may be the crown jewel in environmental restructuring for better health, the city plans to create an urban paradise from an abandoned railroad corridor over the next two decades, with light rail and 22 miles of walking and biking trails.

In Lakewood, Colo., an abandoned shopping mall (a blight now rampant in suburbia) was converted into housing, businesses and play areas.

Syracuse is converting an old saltworks district into a mixed-income, energy-smart housing and business area, giving residents easy access to work and recreation. The local supermarket, Nojaim's, offers health and nutrition classes and weekly health checks, and a mobile farmers' market serves an area that lacks grocery stores.

Another jewel in environmental restructuring is Elgin, Ill., where an island park was created in the middle of the rejuvenated Fox River and a former Superfund site known as auto dealers' row is now Festival Park, giving families a place to gather for water play, picnics and musical performances. A Bikeway Master Plan will eventually connect all the neighborhoods, and easy access to the river has spurred investment.

''For every dollar the city has spent, we have leveraged that into two or three dollars of private investment through new kinds of buildings, row houses and businesses that have opened because the river has a magnetic quality,'' said a former mayor of Elgin, Ed Schock. He might have added another economic benefit: the prospect of lower health care costs.

Further information on healthier communities can be found at designinghealthycommunities.org.

This is the first of three articles on healthier communities. Next week: improving access to walking and cycling. nThis is a more complete version of the story than the one that appeared in print.

PHOTO: ACTIVE ANTIDOTE: Atlanta, where urban sprawl has affected health, is turning an old rail corridor into a trail network. (PHOTOGRAPH BY CHRISTOPHER T. MARTIN)